Prime Time: A New Look At Aging

Technology and aging by category

We keep talking about the future of aging--perhaps so much so that we forget to talk about what's currently available. Here is a partial list of recent technology advances currently being adopted on a wide scale. I offer it so you can see if you or your loved one might benefit from taking advantage of any or all of them.

According to this well thought out article, technology used to benefit seniors falls into three main categories:

"For the purpose of this report, aging-services technologies will be categorized into three broad categories based on the relationship these technologies address between the older adult and his or her environment (safety), oneself (both physical and mental health and wellness), and others (social connectedness)." Okay, although I would add a host of technologies aimed at the general population that have direct or indirect relevance to seniors, such as cellphones, etc.

Under safety, they further break down the category:

Fall detection and prevention technologies
For this class of technologies reliability is highly important. False negatives carry a higher weight than false positives. Reliability information is generally scarce. The effectiveness of these technologies depends on the setting, availability of caregivers and response protocols.

User activated push button on a pendant or wristband such as Philips Life Line (www.LifelineSystems.com), Life Alert (www.lifealert.com), and automatic, such as Tunstall’s wearable fall detector (www.tunstall.co.uk), which is accelerometer and tilt sensing based, and FallSaver (www.fallsaver.net) chair alarm, which is patch that integrates tilt angle measurement

Embedded in the environment (User’s compliance is not required.)
The University of Virginia’s floor vibrations-based fall detector (marc.med.virginia.edu/projects_gaitmonitoring.html), which showed promising reliability on crash-test and anthropometric dummies [19 Objective]; motion-based (Living Independently’s QuietCare, (www.quietcaresystems.com), HealthSense (www.healthsense.com), GrandCare (www.grandcare.com) and many research groups, including Virginia (marc.med.virginia.edu), used motion-based “possible fall” alerting functionality when lack of motion is detected)10; and imaging-based, including SIMBAD and the University of Missouri’s research effort (eldertech.missouri.edu/index.htm).

 Mobility aids (User’s compliance is required.)
Mobility aids, traditionally used to enhance balance and/or help in weight support, are being adapted and enhanced to enable seniors to navigate safely in their environments. Examples include the iBot stair-climbing two-wheel balancing powered wheelchair (www.ibotnow.com), Guido the guiding walker (www.haptica.com/id2.htm), the University of Virginia’s robotic walker (marc.med.virginia.edu/projects_eldercarerob.html) and CMU’s and the University of Michigan’s guiding walker (www.ri.cmu.edu/centers/merit). (Readers of this weblog have seen more and more innovative solutions here.)

For health and 'wellness' technologies, they say:

Includes a base station with or without two-way video, usually with proprietary peripheral sensors, such as BP cuff, scale, spirometer, glucometer, pulse and temperature readers, wired or wireless connectivity (e.g.,  Viterion (www.viterion.com), Honeywell HomMed (www.hommed.com), Philips (www.medical.philips.com/main/products/telemonitoring), WebVMC (www.webvmc.com), Vitel Care (www.vitelnet.com), Health Buddy (www.healthhero.com), etc.). Some are interactive and incorporate condition-specific branching logic.  Imetrikus (www.imetrikus.com/products.asp) has a universal connectivity hub, MetriLink, which allows connecting off the shelf low-cost health products (blood pressure monitors, gloucometers, etc.) to download the data to the Imetrikus Personal Health Record, MediCompass, to be shared with health care professionals.

Wearable
Value proposition may include better health outcome for the person, and reduced health care bills to payers. These technologies entail gross activity monitoring based on accelerometers as well as other sensors. Examples include simple pedometers, actigraphs (e.g. Minimitter’s Actiwatch), and HomeFree’s activity monitors to more sophisticated devices that incorporate physiological measurements, such as skin temperature and metabolic function (e.g. BodyMedia).

Environmental (passive)/non-wearable

These systems are based on embedding sensors in the environment to monitor daily life activities/behavior (such as QuietCare and others including, HealthSense and GrandCare), monitoring activities of daily living (University of Virginia (marc.med.virginia.edu/projects_smarthomemonitor.html)), and monitoring sleep quality (University of Virginia (marc.med.virginia.edu/projects_naps.html), Elite Care (www.elitecare.com)). Mainly targeted at professional and informal caregivers for coordinating care and early detection of decline in function or health issues; do not require user’s compliance. These systems work indoors only, mostly when a person is living alone. If the motion detectors are not pet immune, the presence of pets may affect the accuracy of the inferences and alerts generated by the system.

Hybrid
Hybrid wearable and environmental wellness monitoring systems require a wearable RFID reader and tagging objects in the environment with RFIDs, and they monitor ADLs; these are still in the research phase (e.g., Intel and University of Washington (www.intel.com/research/prohealth)). These technologies require the compliance of the user, and may not be scalable/practicable with existing technologies due to the low reliability and short battery life of the reader.

Telemedicine and Telehealth
Telemedicine technologies are targeted at health care professionals and are used primarily by home health providers, physicians and hospitals, mainly in chronic disease management and for short-term follow-up after hospital discharges, whereas telehealth technologies encompass using them, along with educational information, in self-management of one’s health.

Traditional telemedicine
Includes a base station with or without two-way video, usually with proprietary peripheral sensors, such as BP cuff, scale, spirometer, glucometer, pulse and temperature readers, wired or wireless connectivity (e.g.,  Viterion (www.viterion.com), Honeywell HomMed (www.hommed.com), Philips (www.medical.philips.com/main/products/telemonitoring), WebVMC (www.webvmc.com), Vitel Care (www.vitelnet.com), Health Buddy (www.healthhero.com), etc.). Some are interactive and incorporate condition-specific branching logic.  Imetrikus (www.imetrikus.com/products.asp) has a universal connectivity hub, MetriLink, which allows connecting off the shelf low-cost health products (blood pressure monitors, gloucometers, etc.) to download the data to the Imetrikus Personal Health Record, MediCompass, to be shared with health care professionals.

Ambulatory and wearable monitors
Ambulatory and wearable monitors: Ambulatory and wearable monitors connect via wire—or wirelessly—to a recoding device that sends the data. These include ambulatory electrocardiography device (also known as Holter monitors). An example of these systems is LifeWatch’s (www.lifewatchinc.com/LWTpo_vsm.html) cardiac monitors that use a Bluetooth-enabled cell phone as a data recorder and connectivity gateway. These devices rely on the compliance of the users as well.

Purely interactive Q&A systems
These systems do not have dedicated peripheral measurement devices. An example of these technologies is ZumeLife (www.zumelife.com); these technologies are generally not reimbursable, except possibly under PACE and MA-SNPs.

Video phones and Two-way video stations
These devices are used to connect with a health care professional for telemedicine, televisits, and teleconsults; interventions with these technologies are generally reimbursable with limitations. An example of a simple system is KMEA’s videophone (www.kmea.net).

Passive/environmental/non-wearable
The University of Virginia’s bed monitor for vitals and clinical sleep assessment (under validation) and instrumented walker for gait and balance assessment are examples of this category of telemedicine/telehealth technologies that are under research; such technologies are generally not reimbursable, except possibly under PACE and MA-SNPs.

Medication compliance technologies
These technologies have monitoring, reminding, dispensing features and combinations thereof. Most of these technologies are stand-alone and are targeted at the seniors or the caregiver. Simple monitoring is offered by QuietCare. Intel and Oregon Health and Sciences University (OHSU) (www.orcatech.org/index.php) have prototypes of monitoring and reminding systems and Honeywell HomMed has a medication monitoring and reminding system as part of the telemedicine suite. The Med-eMonitor from Informedix (www.informedix.com) incorporates reminding and educational information/ instructions. The MD2 (www.md2.com) and CompuMed (www.compumed.com) products have the dispensing functionality but may require a professional caregiver to perform the loading and programming. Most products have usability/ user interface issues for elderly users. Many products can be found on the Internet (e.g. on www.epill.com).
 
These devices have the potential to improve health outcomes and reduce cost of care, and to provide peace of mind to informal caregivers, but are generally not reimbursable. There is some preliminary evidence of their effectiveness in improving medication compliance, but more objective evaluation studies, aiming to evaluate their impacts on health outcomes and the cost of care, are warranted.

How is being a Senior different to being anything else?

Straying away from my search for tech toys that can help us get through the aging process as comfortably as possible, I thought I would wish you all a happy 4th of July and spend a few moments on what it really means to be a senior in the United States of America in 2009.

I believe that if you made a list of what 'seniors' need to have a happy and productive Third Age, that it would look remarkably similar to a list of what everybody needs: Being part of a family, a community, a network of friends. Being free from continuous worry about finances or health. Being free from chronic pain, and free from dependence on others. Feeling productive, like someone who contributes to the greater society. Feeling that what you know is of some value to the lives of others. And perhaps most important, having someone to love in your life, and feeling that someone loves you.

There isn't a child, a teenager or younger adult that wouldn't check these off a list of important things to have. So why should we expect seniors to be different? Are there important things I didn't mention? (Tell me in the comments...)

If not, if that's really the list of big things, then the only thing that makes seniors different is that seniors need a little extra help in getting some of those things done. Seniors are not (all) handicapped, but there's a lesson they can learn from those who are challenged by disabilities. Nobody thought worse of John Wayne or Clint Eastwood because they used a stirrup to help them mount a horse. They used one tool to help them use another tool.

That's one reason I enjoy bringing you reports of new tools that can help. Because that's what makes human society different from ants and bees--what we do differently is try new tools and new arrangements and hang on to what works, sometimes discarding older ways of doing things as part of the process.

Seniors have something that is in very short supply in this modern world, and it is something that is greatly needed, if not always recognised. Seniors have experienced change. If you look at the resumes of CEOs and job listings for senior executives, experience of managing change (which basically means going through change and surviving it) is a key criterion for success in this world. And seniors by definition have done it in spades.

It might seem a bit cartoonish to picture yourself as a specialist who requires specialist tools to bring your experience to bear on solving the important problems of life. But from the outside perspective of someone who hopes to be a productive senior in the not-too-distant future, it doesn't seem that far from the truth.

Happy 4th to you all.

The power of the mind in controlling your world

This article describing how Toyota researchers in Japan have built a brain/machine interface (BMI) that has been demonstrated to control a wheelchair using a person's thoughts is important, and not just for wheelchair users.

The idea that human thinking can be transmitted to a device and translated into a command has huge implications for seniors. If the device can use radio to transmit commands, than any device, from your television to your refrigerator, can be operated remotely. Adjusting your bed, changing your channel, operating your telephone--it will indeed be a different world. Mobility will not be just limited to wheelchairs. Exoskeletons that you wear like a fashion-conscious spacesuit already exist and can walk up stairs as well as down the street. Powered by thought impulses, they could take many out of a wheelchair entirely.

"The system enables a person to make a wheelchair turn left or right to move forward simply by thinking the commands. The response time is in 125 milliseconds. One millisecond is equal to 1/1000 of a second.

The BMI was developed at the BSI-Toyota Collaboration Center (BTCC), a 2-year-old research center established by Japan's government research unit RIKEN and Toyota Motor, Toyota Central R&D Labs, and Genesis Research Institute. Japan has focused on the control of devices through brain waves as a way to deal with the projected shortage of healthcare workers to tend to Japan's large aging population.

The BTCC's system uses several sensors placed over the areas of the brain that control motion to measure electrical activity in the region. The electical impulses triggered by the rider thinking of turning or moving the wheelchair are picked up and analyzed by an onboard laptop that passes the commands on to the wheelchair.

The system has an emergency stop that can be activated by the user puffing his cheeks.

The BMI adjusts itself over time to the characteristics of each driver's brainwaves. If a person dedicates three hours a day to using the system, the BMI can reach 95% accuracy in a week, researchers said."

I'm excited by all of this--I was an avid science fiction fan in my youth, and we're finally seeing the inventions postulated back then come to reality. Sadly, though, it makes science fiction of today seem a bit pedestrian. But living in the future has its compensations.

Helping those who help seniors

From the Center for Aging Services Technologies (CAST) comes this report on helping caregivers:

Family caregivers are a critical component in elder home care. Employed caregivers carry an additional set of workplace demands that overlay their caregiving responsibilities, yet no supportive technology based applications exist for them. 

Through funding from the Dept of Commerce's Technology Opportunity Program (TOP), we developed and tested the first technology based system designed to support working caregivers concerned about older adults alone at home during the caregiver's worktime. Known as the Worker Interactive Networking (WIN) project, it innovatvely offered workplace Internet access via PC/PDA/cellphone to a uniquely integrated system providing a caregiver support group, resource linkages, and remote home monitoring of consenting elders. 

The home monitoring system consisted of 2 in. wireless event sensors unobtrusively placed in the home that sent data via a transponder that uploaded it to our server that filtered and updated status information in real time. Workers logged on to their personal webpage to see their relatives status at three levels, each with increasing specificity of information. If everything was fine, they saw a Green "OK", when a parameter neared its' limit, a Yellow "Watch" was displayed and if exceeded a Red "Alert" was shown. Alerts automatically triggered an e-mail notifying the caregiver. Caregivers could click on the alert or any of the non-alert screens to proceed further down for specific information on the status indicators such as when the elder got up, the last time they moved about, where they went, if they went into their pill box, or went out the door. 

After the caregivers/elders chose what to monitor, we used a "Nursense" (TM) assessment process to assess for and offer other preventive health and safety options. Endusers were given the control over the monitoring times and could change settings at any time or turn them off.

Tell a friend.

You're already a winner

In order to read what I'm writing here, you have mastered a set of tools (computer, mouse, internet, finding an address, etc.) that give you an advantage in staying self-reliant and independent.

A 2006 article titled 'Factors predicting the use of technology: Findings from the center for research and education on aging and technology enhancement (create)' and published in Psychology and Aging reports on a study of 1,204 individuals. "The successful adoption of technology is becoming increasingly important to functional independence. The present article reports findings from the Center for Research and Education on Aging and Technology Enhancement (CREATE) on the use of technology among community-dwelling adults."

This makes sense to me--learning anything new helps keep you flexible. Assuming you choose to learn something relevant to you, it should help you in concrete ways. Learning technology keeps you close to the present, and the tools themselves provide ways to communicate, solve problems and stay part of the world. Which means I will probably have to learn how (and even why) to use Twitter...

The article goes on to say, "All participants completed a battery that included measures of demographic characteristics, self-rated health, experience with technology, attitudes toward computers, and component cognitive abilities. Findings indicate that the older adults were less likely than younger adults to use technology in general, computers, and the World Wide Web. The results also indicate that computer anxiety, fluid intelligence, and crystallized intelligence were important predictors of the use of technology. The relationship between age and adoption of technology was mediated by cognitive abilities, computer self-efficacy, and computer anxiety."

So, yes, it's tougher to stay on top of things as we get older. But it's obviously worth it. So, I'll give you about 30 seconds to feel good about yourselves.... ready? Now go teach someone else how to do what you have learned. Pass it on.

A bit more on Aubrey de Grey

Some time back, a reporter from MIT Review paid Aubrey de Grey, the man who thinks he can defeat aging, at his home in Cambridge. The longish article that resulted from that visit is well worth a read and can be found here.

Mr. de Grey thinks that aging consists of lots of little breakdowns that accumulate over time and cause the body's mechanism to deteriorate. He is optimistic that addressing each individual breakdown can stop aging--he thinks like an engineer, not a visionary.

For now, here's a summary of how he thinks aging can be addressed.

"De Grey calls his program Strategies for Engineered Negligible Senescence, which permits him to say that it makes SENS to embark upon it. Here, in no particular order, follow his seven horsemen of death and the formulations for the breaking of each animal and its rider. (Those seeking more detailed information might wish to consult de Grey's website: www.gen.cam.ac.uk/sens/index.html.)

1. Loss and atrophy or degeneration of cells. This element of aging is particularly important in tissues where cells cannot replace themselves as they die, such as the heart and brain. De Grey would treat it primarily by the introduction of growth factors to stimulate cell division or by periodic transfusion of stem cells specifically engineered to replace the types that have been lost.

2. Accumulation of cells that are not wanted. These are (a) fat cells, which tend to proliferate and not only replace muscle but also lead to diabetes by diminishing the body's ability to respond to the pancreatic hormone insulin, and (b) cells that have become senescent, which accumulate in the cartilage of our joints. Receptors on the surface of such cells are susceptible to immune bodies that de Grey believes scientists will in time learn how to generate, or to other compounds that may make the cells destroy themselves without affecting others that do not have those distinctive receptors.

3. Mutations in chromosomes. The most damaging consequence of cell mutation is the development of cancer. The immortality of cancer cells is related to the behavior of the telomere, the caplike structure found on the end of every chromosome, which decreases in length each time the cell divides and therefore seems to be involved with the cell's mortality. If we could eliminate the gene that makes telomerase -- the enzyme that maintains and lengthens telomeres -- the cancer cell would die. De Grey's solution for this problem is to replace a person's stem cells every 10 or so years with ones engineered not to carry that gene.

4. Mutations in mitochondria. Mitochondria are the micromachines that produce energy for the cell's activities. They contain small amounts of DNA, which are particularly susceptible to mutations since they are not housed in the chromosomes of the nucleus. De Grey proposes copying the genes (of which there are 13) from the mitochondrial DNA and then putting those copies into the DNA of the nucleus, where they will be far safer from mutation-causing influences.

5. The accumulation of "junk" within the cell. The junk in question is a collection of complex material that results from the cell's breakdown of large molecules. Intracellular structures called lysosomes are the primary microchambers for such breakdown; the junk tends to collect in them, causing problems in the function of certain types of cells. Atherosclerosis, hardening of the arteries, is the biggest manifestation of these complications. To solve this difficulty, de Grey proposes to provide the lysosomes with genes to produce the extra enzymes required to digest the unwelcome material. The source of these genes will be certain soil bacteria, an innovation based on the observation that ground that contains buried animal flesh does not show accumulation of degraded junk.

6. The accumulation of "junk" outside the cell. The fluid in which all cells are bathed -- called extracellular fluid -- may come to contain aggregates of protein material that it is incapable of breaking down. The result is the formation of a substance called amyloid, which is the material found in the brains of people with Alz heimer's disease. To counter this, de Grey proposes vaccination with an as-yet undeveloped substance that might stimulate the immune system to produce cells to engulf and eat the offending material.

7. Cross-links in proteins outside the cell. The extracellular fluid contains many flexible protein molecules that exist unchanged for long periods of time, whose function is to give certain tissues such qualities as elasticity, transparence, or high tensile strength. Over a lifetime, occasional chemical reactions gradually affect these molecules in ways that change their physical and/or chemical qualities. Among these changes is the development of chemical bonds called cross-links between molecules that had previously moved independently of one another. The result is a loss of elasticity or a thickening of the involved tissue. If the tissue is the wall of an artery, for example, the loss of distensibility may lead to high blood pressure. De Grey's solution to this problem is to attempt to identify chemicals or enzymes capable of breaking cross-links without injuring anything else.

It must be obvious that, even condensed and simplified as they are here, these seven factors are enormously complex biological problems with even more complex proposed solutions. At least some of those solutions may prove inadequate, and others may be impossible to implement. Moreover, de Grey's descriptions are sprinkled with such vague phrases as "growth factors" and "stimulate the immune system," which might prove to be little more than slogans, as when he invokes yet-to-be-discovered "chemicals or enzymes capable of breaking cross-links without injuring anything else." In addition, it must be emphasized that researchers have not come close to solving a single one of the seven problems. In the case of several, there have been promising results. Indeed, research on extracellular cross-links has already yielded several drug candidates: a company called Alteon, in Parsippany, NY, has begun clinical trials of molecules that it says can reverse the effects of some conditions associated with age. In the cases of some of the other problems de Grey identifies, however -- such as the prevention of telomere lengthening or the transfer of mitochondrial DNA to the nucleus -- it is fair to say that molecular biologists can only speculate about the day, if ever, when these attempts will come to fruition."

Aubrey de Grey--the man who wants to defeat aging

Here's an introduction for a man you will see appear often in this weblog. His name is Aubrey de Grey. First, I really want to say that I like his beard very much. Second, his continuing focus on overcoming the separate processes that combine to cause aging and the decay of physical processes is certain to be a significant contribution to whatever progress is made in advancing longevity. I'll keep this short--here's what Wikipedia has to say about him.

 

From Wikipedia, the free encyclopedia

Aubrey de Grey
Aubrey de Grey, 2008
Born	April 20, 1963 (age 46) London, England
Residence	Cambridge, England
Nationality	British
Ethnicity	England
Fields	Biogerontology
Institutions	University of Cambridge
Alma mater	University of Cambridge
Known for	SENS, Methuselah Mouse Prize

Aubrey David Nicholas Jasper de Grey (born 20 April 1963 in London, England) is an English biomedical gerontologist.

De Grey is the author of the mitochondrial free-radical theory of aging, and the general-audience book Ending Aging, a detailed description of how regenerative medicine may be able to thwart the aging process altogether within a few decades. He works on the development of what he has termed "Strategies for Engineered Negligible Senescence" (SENS) - a tissue-repair strategy intended torejuvenate the human body and thereby allow an indefinite lifespan. To this end, he has identified seven types of molecular and cellular "damage" caused by essential metabolic processes; SENS is a proposed panel of therapies to repair this damage.^[1]

De Grey has been interviewed in recent years in many news sources, including CBS 60 Minutes, BBC, the New York Times, Fortune Magazine, the Washington Post, TED, Popular Science and The Colbert Report. His main activities at present are as Chief Science Officer of the SENS Foundation^[2] and editor-in-chief of the academic journal Rejuvenation Research.

When Second Prize is Good Enough

When a scientist says something can be done, believe him or her and add about 15 years to the timeline they give you for completion. But when a scientist says something cannot be done--they are (so far) almost always wrong.

So when Massachussetts Institute of Technology writes that it is 'absurd' to think that aging can be 'cured' in the way a disease might be cured, you don't have to be convinced just by their stellar reputation. Although they are probably right, science has a way of getting in through the back door when the front door is locked, and may find a way to prolong lifespans without finding a cure.

What MIT offers as a consolation prize is almost equally as welcome--and startling. Current research is on the way to treatments and technologies that will 'compress morbidity'--that is, shorten the amount of time people are unhealthy prior to their deaths. Or as MIT put it,

"While it is highly unlikely that aging can be permanently halted at the cellular level, antiaging science might allow doctors to "compress the morbidity" of their patients: that is, reduce the amount of time geriatric patients suffer from the chronic diseases of old age like heart disease, macular degeneration, senile diabetes, or dementia. Such therapies would also extend human life -- at least a little bit, anyway. Human beings could live beyond the age of 80 or 90, and in relatively good health. And while that's not immortality, it offers something like happiness on a reasonable, human scale."

That's a second prize I can live with--at least for now.

Technology and seniors--this week

It used to be that companies and innovators concentrated on the young and all but ignored seniors. That no longer seems to be the case. Here's one week in technology for seniors:

June 17, 2009

At the Boomer Venture Summit in Santa Clara, CA, firstSTREET and MyGait today unveiled a "failure-free and fear-free" computer especially conceived for and by seniors over an eight-year period of hands-on research at senior centers and assisted living communities around the country. The "designed for SENIORS GO Computer™" was developed down to the last detail, from its large-letter keyboard to its fool-proof operating system, to accommodate the needs and wishes of a demographic that has traditionally resisted the world of computers or had the hardest time accessing it. "And these are the very people," says Gordon, "who may well benefit most from email and Internet access."

June 17, 2009

Varian Medical Systems (NYSE: VAR) and Providence Health and Services (PH&S) have signed a three-year agreement for Varian to provide PH&S treatment centers with advanced radiotherapy technology for treating cancer. The agreement covers Varian's state-of-the-art equipment and software.

June 15, 2009

Remote cardiac monitoring company LifeWatch inked an exclusive carrier agreement with Verizon Wireless for its mobile phone-based service for cardiac patients.

June 15, 2009

MedApps: Remote wireless telemonitoring vendor MedApps received clearance from the FDA this past week for its HealthPAL product. HealthPAL is the small, portable dedicated device that MedApps uses to collect data from connected glucose meters, blood pressure monitors, pulse oximeters and weight scales. The data is then sent over a secure server to an online portal like Microsoft’s HealthVault or Google Health for caregivers, physicians or the patient themselves to view.

June 15, 2009

Apple unveiled its latest iPhone model at the annual World Wide Developers Conference last week, the iPhone 3GS, and showed off the new iPhone operating system 3.0. The new OS includes specifications that allow connected medical device makers to pair their devices with the iPhone via Bluetooth. Johnson & Johnson's LifeScan unit demonstrated a concept of just such a product earlier this year with a connected blood glucose monitor that interfaced with an iPhone application for diabetes management. At a WWDC event earlier this week, Apple invited AirStrip Technologies on-stage to demonstrate its cardiac monitoring application for clinicians

June 10, 2009

Rocky Mountain Marketing, after 5 years of marketing, research and development has released to the public, their state-of-the-art rehabilitation aid, the Shoe & Boot Valet(TM). The Shoe & Boot Valet(TM) delivers, in one innovative product, a tool that can put on and take off footwear with just one hand. The Shoe & Boot Valet(TM) is perfect for maintaining an active, healthy and independent lifestyle while providing comfort to those with limited mobility.

Designed for easy use in the home, in outpatient rehabilitation clinics, and in assisted-living settings, this nonprescription breakthrough device represents a significant advance for people with difficulty putting on and taking off their footwear due to either acute or chronic pain conditions that arise from illness, inflammation, injury or surgery or as a result of aging. At last, a product comes along that offers unprecedented flexibility for both the user and the caregiver alike.

Preserving Domesticated Tranquility

Domesticated animals live much longer than their counterparts in the wild. Cats, dogs, even birds live two to three times longer--as long as they stay close to man.

It's true for us, too. Our lifespan began to climb dramatically as we moved further away from the 'nasty, brutish and short' lifestyles of our ancestors. As recently as 2,000 years ago, the average lifespan was about 21.

Now that the average lifespan in the developed world is pushing 80, what more can we expect? Life expectancy rose from 48 to 78 in between 1900 and 2000 in this country--is it reasonable to hope that it will reach 108 by 2100? Is it possible that that's an underestimate? Cats generally live to be 4 in the wild, but can reach 16 in captivity...

At Sage, Chris Mooney summarises recent research:

"All things being equal, these are pretty good days to be an elderly American. Not only has average life expectancy been rising steadily since 1950, but, over the past 2 decades, surveys have shown a steady decline in disability among older Americans, a trend that continues unabated. "We haven't seemed to reach a plateau yet," says Harvard University health economist David Cutler, who studies disability among the elderly. And the good news doesn't stop there: Scientists have discovered a number of ways to slow aging in creatures as different as yeast and mice. This ongoing research into aging and longevity has "immense potential to prevent late-life illnesses and prolong active life" in humans, wrote gerontologist Richard A. Miller of the University of Michigan, Ann Arbor, last November in the health care policy journal The Milbank Quarterly."

"...The discovery over the past decade of a large number of genetic changes that can prolong life in a variety of animals has spurred scientists to look deeper for explanations of what they're seeing. So far, however, there's a raft of ideas but no clear winner.

Consider just one example out of many. Martin Holzenberger of the French biomedical research agency INSERM is the lead author of a recent study showing that mice genetically engineered to respond poorly to the hormone insulin-like growth factor 1 (IGF-1), which controls growth and cell division, live 26% longer on average than do normal lab mice (see "All Together Now"). In flies and worms, related genes have a similar effect, an evolutionary commonality that researchers find intriguing."

But you may have to fight for the chance to see your second century.

"...Whether one mechanism or many drive the aging process, most scientists in the field agree that the research has already shown its medical promise and deserves better federal funding--particularly because, as Miller points out, putting the brakes on aging would also reduce the incidence of a wide range of illnesses that plague the elderly. Because of the potential payback, "it's terribly important to invest more on fundamental research in the processes of aging," says George Martin, a pathologist at the University of Washington, Seattle, who studies aging and Alzheimer's disease. "It will be very cost effective. You might not find a unitary mechanism for everything, but you might find some very important ones that you can deal with for a large segment of the population."

Despite the immense implications of new findings about the biology of aging for humans, Miller argues that basic research in this area remains drastically underfunded and neglected by policymakers. Miller notes in his piece in The Milbank Quarterly that research on aging "receives such a small proportion of government research funding that it cannot be seen in [the] pie chart." The overall budget of NIA is $1 billion a year, approximately 20% of which goes to basic research into the biology of aging, according to NIA's Warner. In comparison, the National Cancer Institute has a budget of roughly $4 billion a year. According to Warner, many promising research proposals in the biology of aging remain unfunded with the institute's current budget. But that's probably true of every part of the National Institutes of Health: "There's probably not a biomedical constituency that doesn't believe that it's underfunded," he points out.

Why does research into the biology of aging receive such a meager amount of funding? Miller has several ideas. First, he says, politicians tend to be most responsive to voter demands for research into specific diseases such as cancer and Alzheimer's, a nearsightedness shared by pharmaceutical companies. Further complicating matters is the phenomenon of "gerontologiphobia," a fear of the social consequences of life span extension that has been on prominent display by some members of the President's Council on Bioethics and particularly its chair, Leon Kass."